National survey on the current status of airway management in China

Apparently, understanding airway management status may help to reduce risk and improve clinical practice. Given these facts, our team conducted a second survey on the current status of airway management for mainland China following our 2016 national airway survey. The national survey was conducted from November 7 to November 28, 2022. An electronic survey was sent to the New Youth Anesthesia Forum, where Chinese anesthesiologists completed the questionnaire via WeChat. A total of 3783 respondents completed the survey, with a response rate of 72.14%. So far, in 2022, 34.84% of anesthesiologists canceled or delayed surgery at least once due to difficult airway. For the anticipated difficult airway management, 66.11% of physicians would choose awake intubation under sedation and topical anesthesia, while the percentage seeking help has decreased compared to the 2016 survey. When encountering an emergency, 74.20% of respondents prefer to use the needle cricothyrotomy, albeit less than a quarter have actually performed it. Anesthesiologists with difficult airway training experience reached 72.96%, with a significant difference in participation between participants in Tier 3 hospitals and those in other levels of hospitals (P < 0.001). The videolaryngoscope, laryngeal mask, and flexible intubation scope were equipped at 97.18%, 95.96%, and 62.89%, respectively. Additionally, the percentage of brain damage or death caused by difficult airways was significantly decreased. The study may be the best reference for understanding the current status of airway management in China, revealing the current advancements and deficiencies. The future focus of airway management remains on training and education.


Tables
# The definition of a difficult airway is as follows [1,2] .
Difficult Facemask Ventilation: Inability to provide adequate ventilation (absence of end-tidal carbon dioxide detection waveform) to the patient due to one or more of the following reasons: insufficient mask seal, excessive gas leakage, or excessive resistance to gas flow entry or exit.Signs of inadequate ventilation include (but are not limited to): no or inadequate chest movement, absent or inadequate breath sounds on auscultation, signs of severe obstruction, cyanosis, gastric air entry or dilatation, decreasing or inadequate oxygen saturation, absent or inadequate exhaled gas flow as measured by spirometry, anatomic lung abnormalities as detected by lung ultrasound, and hemodynamic changes associated with hypoxemia or hypercarbia (e.g., hypertension, tachycardia, bradycardia, arrhythmia).
Difficult Supraglottic Airway Ventilation: Adequate ventilation cannot be provided because of one or more of the following issues: difficult supraglottic airway placement, the need for multiple attempts to place the supraglottic airway, inadequate sealing of the supraglottic airway, excessive gas leakage, or excessive resistance to gas entry or exit.
Difficult Laryngeal Exposure: After several attempts at direct laryngoscopy or videolaryngoscopy, it is impossible to see any portion of the vocal cords.
Difficult Tracheal Intubation: Tracheal intubation requires multiple attempts, additional operators, devices, and/or assistive techniques to be successful or failure of tracheal intubation after multiple attempts.
Difficult Tracheal Extubation: The loss of airway patency and adequate ventilation after removal of a tracheal tube or supraglottic airway from a patient with a known or suspected difficult airway (i.e., an "at risk" extubation).
Difficult emergency front of neck access: Anatomic features or abnormalities reduce or prevent the likelihood of successfully placing an airway into the trachea through the front of the neck.
† Our survey was conducted on a per-hospital basis, not general anesthesia cases.for brain damage or death.The number of general anesthesia surgeries in China in 2022 is about 70 million, so the number of brain damage or death is roughly 3,840 (5.13%*75,477), which translates into a ratio of 1 in 180,000 general anesthesia cases (3,840 cases/70million general anesthesia cases), which approximates the findings of NAP4 [3] .FONA: emergency Front of neck access; AIST: Awake intubation under sedation and topical anesthesia; GASB: General anesthesia with preserved spontaneous breathing; RSAI: rapid sequence anesthesia induction.

Table S2 Table S2
National Airway Management Status Questionnaire and Responses Comparison of difficult airway management for different levels of hospitals

Part 6. Difficult airway management outside the operating room Q22
. What do you think are the top three devices you should take to intubate outside the operating room?【Multiple Choice】

Availability of airway devices and emergency airway devices *
* These questions can only be answered by the director of the Department of Anesthesiology.

Part 9. Adverse events related to difficult airway *
According to the China Health Statistics Yearbook 2022 (http://www.nhc.gov.cn), the number of medical institutions covered by our survey is about 75,477.It showed an event rate of 5.13% Supplementary TableS3Comparison of difficult airway management for Anesthesiologists with different years of working length AIST: Awake intubation under sedation and topical anesthesia; GASB: General anesthesia with preserved spontaneous breathing; RSAI: Rapid sequence anesthesia induction; FONA: Front of neck access.